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Management of Periprocedural and Early Pericardial Effusions With Tamponade Following Ablation of Atrial Fibrillation With Uninterrupted Factor Xa Inhibitors: A Case Series.
- Source :
- Journal of Cardiovascular Electrophysiology; Apr2016, Vol. 27 Issue 4, p399-403, 5p, 2 Charts
- Publication Year :
- 2016
-
Abstract
- Management of Tamponade Following AF Ablation With FXaI Introduction Because of the absence of a dedicated reversal agent, the outcome of pericardial effusion (PE) following procedures performed with uninterrupted apixaban or rivaroxaban is unknown. We report the characteristics of PEs presenting with tamponade in patients undergoing AF ablation with uninterrupted factor Xa inhibition (FXaI) to understand their management and prognosis. Methods and Results We performed a multicenter cross-sectional survey in 10 centers across the United States. Patient data were obtained by chart review. In all patients the procedure was performed with uninterrupted FXaI. A total of 16 PEs requiring intervention were reported from 5 centers. Two patients were on apixaban 5 mg BD, the remaining on rivaroxaban 20 mg OD. Eleven PEs occurred in the periprocedural setting, and 5 PEs occurred from 1 to 28 days after the procedure. Pericardiocentesis and drainage were performed in all cases. Protamine and 4-factor prothrombin complex concentrate (4F-PCC) were given in all periprocedural cases. Two patients required surgery: in one case coagulation of the pericardial blood prevented effective drainage, and in the other bleeding was secondary to a steam pop-induced atrial tear. None of the postprocedural cases required FXaI reversal and the dose of rivaroxaban was temporarily reduced. No fatal outcomes or thromboembolic events were reported. Conclusion Pericardiocentesis and drainage with FXaI reversal proved effective in the management of acute PEs with tamponade occurring periprocedurally in patients undergoing AF ablation with uninterrupted FXaI. Early postprocedural effusions can be treated with pericardiocentesis without the need of a reversal agent. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTICOAGULANTS
CARDIAC tamponade treatment
ATRIAL fibrillation
BLOOD transfusion
BLOOD coagulation factors
CARDIAC tamponade
CATHETER ablation
ECHOCARDIOGRAPHY
FLUOROSCOPY
MEDICAL cooperation
PERICARDIUM paracentesis
RESEARCH
SURVEYS
CROSS-sectional method
RETROSPECTIVE studies
PROTAMINES
DATA analysis software
DESCRIPTIVE statistics
MEDICAL drainage
PERICARDIAL effusion
RIVAROXABAN
CHEMICAL inhibitors
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 10453873
- Volume :
- 27
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Journal of Cardiovascular Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 114514223
- Full Text :
- https://doi.org/10.1111/jce.12918